MEDICARE: PRODEO ACADEMY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)	4213	MN

General Provider Information

NPI Number	:	1790108512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRODEO ACADEMY

Provider Business Mailing Address
First Line	:	1555 40TH AVE NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55421-3103
Country	:	US
Telephone Number	:	763-205-9950
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 40TH AVE NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55421-3103
Country	:	US
Telephone Number	:	763-205-9950
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	CHANCEY ANDERSON
Credential	:
Telephone Number	:	347-982-5061

Provider Enumeration Date	:	01/30/2014
Last Update Date	:	01/30/2014

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Directions to “PRODEO ACADEMY ” Practice Location

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